Journal of Food and Nutrition Research
ISSN (Print): 2333-1119 ISSN (Online): 2333-1240 Website: Editor-in-chief: Prabhat Kumar Mandal
Open Access
Journal Browser
Journal of Food and Nutrition Research. 2018, 6(1), 62-68
DOI: 10.12691/jfnr-6-1-10
Open AccessArticle

Changes in Food Consistency Improve Quality of Life Related to Swallowing in Post-stroke Patients at Risk of Dysphagia

Daiana Cristina Dessuy Vieira1, , Carine Cristina Callegaro2, Adriane Schmidt Pasqualoto3 and Ligia Beatriz Bento Franz4

1Northeast Regional University of the State of Rio Grande do Sul, Department of Life Sciences, Nutrition. Ijuí, Rio Grande do Sul, Brazil

2Federal University of Santa Maria (UFSM), Department of Physical Therapy and Rehabilitation, Physiology and Rehabilitation Laboratory, Santa Maria, Rio Grande do Sul, Brazil

3Federal University of Santa Maria (UFSM), Specialization in physical-motor rehabilitation, Postgraduate Program in Human Communication Issues, Santa Maria, Rio Grande do Sul, Brazil

4Regional State University of Northwestern Rio Grande do Sul, Department of Life Sciences, Nutrition Course, Sensu Stricto Graduate Program in Comprehensive Health Care in the Regional State University of Northwestern Rio Grande do Sul Extension / Cruz Alta University, Rua do Comércio, 3000, 98700-000, Bairro Universitário, Ijuí, Rio Grande do Sul, Brazil

Pub. Date: January 29, 2018

Cite this paper:
Daiana Cristina Dessuy Vieira, Carine Cristina Callegaro, Adriane Schmidt Pasqualoto and Ligia Beatriz Bento Franz. Changes in Food Consistency Improve Quality of Life Related to Swallowing in Post-stroke Patients at Risk of Dysphagia. Journal of Food and Nutrition Research. 2018; 6(1):62-68. doi: 10.12691/jfnr-6-1-10


This study aimed to evaluate the effects of change in food consistency on the nutritional status and quality of life of patients at risk of dysphagia. Twenty-five post-stroke patients receiving outpatient care in a physical rehabilitation clinic participated in the study. Subjects were grouped into those with and those without risk for dysphagia. The Eating Assessment Tool (EAT-10) was applied as a tool to assess the risk of dysphagia. The participants’ nutritional status was evaluated through a Mini nutritional assessment (MNA) and anthropometric measures. Quality of life as it relates to swallowing disorders was determined by using the Quality of Life in Swallowing Disorders questionnaire. For patients at risk of dysphagia, there were changes in the consistency of food as well as conventional treatment. For patients without risk of dysphagia, only conventional treatment was offered. All patients were reevaluated in the first and second month after the modifications. Twelve patients (69 ± 7 years) were classified as being the at-risk group and 13 patients (66 ± 10 years) were classified as not being at risk of dysphagia. Patients at risk of dysphagia presented poorer quality of life related to swallowing in the following areas: perceiving swallowing as a burden, duration of feeding, fear, mental health, social health, fatigue, and sleep. After the intervention, symptoms improved only in patients at risk of dysphagia, while the perception of health improved in both groups. Nutritional status did not change in either group. Change in the consistency of food improves symptoms related to swallowing in patients at risk of dysphagia. The perception of general health improves in patients with and without risk of dysphagia who participate in a physical rehabilitation program.

stroke quality of life dysphagia

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  World Health Organization Media Centre. Cardiovascular diseases (CVDs) Fact sheet 2013. Accessed on: 22/08/2015.
[2]  Jorge MHPM, Laurenti R, Lima-Costa MF, Gotlieb SLD, Chiavegatto Filho ADP. Brazilian Mortality of Elderly Persons: The Question about ill-defined Underlying Causes of Death. Epidemiol Serv Saúde. 2008; 17(4): 271-281.
[3]  Ryerson S, Byl NN, Brown DA, Wong RA, Hidler JM. Altered trunk position sense and its relation to balance functions in people post-stroke. J Neurol Phys Ther. 2008; 32(1): 14-20.
[4]  Cruz KC, Diogo MJ. Evaluation of functional capacity in elders with encephalic vascular accident. Acta Paul Enferm. 2009; 22(5): 666-672.
[5]  Nunes MCA, Jurkiewicz AL, Santos RS, Furkim AM, Massi G, Pinto GSA, et al. Correlation between brain injury and dysphagia in adult patients with stroke. Int Arch Otorhinolaryngol. 2012; 16(3):313-21.
[6]  Itaquy RB, Favero SR, Ribeiro MC, Barea LM, Almeida ST, Mancopes R. Dysphagia and cerebrovascular accident: relationship between severity degree and level of neurological impairment. J Soc Bras Fonoaudiol. 2011; 23(4), 385-389.
[7]  Paixão Teixeira C, Silva LD. As incapacidades físicas de pacientes com acidente vascular cerebral: ações de enfermagem. Enferm glob. 2009; 15: 1-12.
[8]  Clave P, de Kraa M, Arreola V, Girvent M, Farre R, Palomera E, et al. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther. 2006; 24(9): 1385-1394.
[9]  Gonçalves MIR, Remaili CB, Behlau M. Cross-cultural adaptation of the Brazilian version of the Eating Assessment Tool - EAT-10. CoDAS 2013; 25(6): 601-604.
[10]  Rocha PECP. Avaliação Antropométrica. In: Rocha, Paulo Eduardo Carnaval Pereira. Medidas e avaliação: em ciências do esporte. 4ed. Rio de Janeiro: SPRINT; 2000. p. 17-72.
[11]  Chumlea WC, Roche AF, Steinbaugh ML. Estimating stature from knee height for persons 60 to 90 years of age. J Am Geriatr Soc. 1985; 33(2): 116-120.
[12]  World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation (WHO Technical Report Series 894); 2000.
[13]  OPAS. Organização Pan-Americana .XXXVI Reunión del Comitê Asesor de Ivestigaciones en Salud - Encuestra Multicêntrica - Salud Beinestar y Envejecimeiento (SABE) en América Latina e el Caribe - Informe preliminar. Washington, D.C. XXXVI Reunión del Comité Asesor de Investigaciones en Salud. Kingston, Jamaica - 9-11 de julio de 2001.
[14]  Beghetto MG, Luft VC, Mello ED, Polanczyk CA. Accuracy of nutritional assessment tools for predicting adverse hospital outcomes. Nutr Hosp. 2009; 24(1): 56-62.
[15]  Harrison GG, Buskirk ER, Carter JEL, Johnston FE, Lohman TG, Pollock ML, et al. Skinfold thicknesses and measurement technique. In: Lohman TG, Roche AF, Martorell R, editors. Anthropometric standardization reference manual. Champaign (Illinois): Human Kinetics Books; 1988. p. 55-70.
[16]  Yamatto TH. Avaliação Nutricional. In: Toniolo Neto J, Pintarelli VL, Yamatto TH. A Beira do Leito: Geriatria e Gerontologia na prática Hospitalar. Barueri: Manole; 2007. p 23.
[17]  Heyward VH, Stolarczyk LM. Método de Impedância. Bioelétrica. In: Heyward, Vivian H.; Stolarczyk, Lisa M. Avaliação da composição corporal aplicada. São Paulo: Manole; 2000. p. 47-60.
[18]  Portas JG. Validação para a língua portuguesa-brasileira dos questionários: qualidade de vida em disfagia (Swal-qol) e satisfação do paciente e qualidade do cuidado no tratamento da disfagia (Swal-care). São Paulo. Programas de Pós-graduação da CAPES, Fap/Oncologia, (programa de Mestrado em Medicina). Fundação Antônio Prudente. 2009, p. 58.
[19]  Leow LP, Huckabee ML, Anderson T, Beckert L. The Impact of dysphagia on quality of life in ageing and Parkinson’s Disease as measured by the swallowing quality of life (SWAL-QOL) questionnaire. Dysphagia. 2010; 25(3): 216-220.
[20]  National Dysphagia Diet Task Force, American Dietetic Association. National Dysphagia Diet: Standardization for Optimal Care. American Dietetic Association 2002.
[21]  Schelp A, Cola PC, Gatto A, Silva RG, Carvalho L. Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência. Arq Neuropsiquiatr, 2004; 62 (2-B): 503-506.
[22]  Michou E, Hamdy S. Cortical input in control of swallowing. Curr Opin Otolaryngol Head Neck Surg, 2009; 17(3): 166-171.
[23]  Perry L, Love CP. Screening for dysphagia and aspiration in acute stroke: a systematic review. Dysphagia. 2001; 16(1): 7-18.
[24]  Runions S, Rodrigue N, White C. Practice on an acute stroke unit after implementation of a decision-making algorithm for dietary management of dysphagia. J Neurosci Nurs. 2004; 36(4): 200-207.
[25]  Dávalos A, Ricart W, Gonzalez-Huix F, Soler S, Marrugat J, Molins A, et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke. 1996; 27(6): 1028-1032.
[26]  Rodrigue N, Côté R, Kirsch C, Germain C, Couturier C, Fraser R. Meeting the nutritional needs of patients with severe dysphagia following a stroke: an interdisciplinary approach. Axone. 2002; 23(3): 31-7.
[27]  European Society for Swallowing Disorders (2012) ESSD Position Statements: Oropharyngeal Dysphagia in Adult Patients. Dysphagia. 2013; 28: 280-33.
[28]  Ney DM, Weiss J, Kind A, Robbins J. Senescent Swallowing: Impact, Strategies and Interventions. Nutr Clin Pract. 2009; 24(3): 395-413.
[29]  Germain I, Dufresne T, Gray-Donald K. A novel dysphagia diet improves the nutrient intake of institutionalized elders. J Am Diet Assoc. 2006; 106(10): 1614-1623.
[30]  Perry L. Screening swallowing function of patients with acute stroke. Part two: Detailed evaluation of the tool used by nurses. J Clin Nurs. 2001; 10(4): 474-481.
[31]  Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the Eating Assessment Tool (EAT-10) Ann Otol Rhinol Laryngol. 2008; 117(12): 919-924.
[32]  Schelp AO, Cola PC, Gatto AR, da Silva RG, de Carvalho LR. Incidence of oropharyngeal dysphagia associated with stroke in a regional hospital in Sao Paulo State - Brazil. Arch Neuropsiquiatr. 2004; 62(2B): 503-506.
[33]  Crary MA, Humphrey JL, Carnaby-Mann G, Sambandam R, Miller L, Silliman S. Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care. Dysphagia. 2013; 28(1): 69-76.
[34]  Finestone HM, Greene-Finestone LS. Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional management for stroke patients. CMAJ. 2003; 169(10): 1041-1044.
[35]  Thomas L, Jones TM, Tandon S, Katre C, Lowe D, Rogers SN. An evaluation of the University of Washington Quality of Life swallowing domain following oropharyngeal cancer. Eur Arch Otorhinolaryngol. 2008; 265 Suppl 1: 29-37.
[36]  Finizia C, Rudberg I, Bergqvist H, Rydén A. A cross-sectional validation study of the Swedish version of SWAL-QOL. Dysphagia. 2012; 27(3): 325-335.
[37]  Vanderwegen J, Van Nuffelen G, De Bodt M. The validation and psychometric properties of the Dutch version of the Swallowing Quality-of-Life Questionnaire (DSWAL-QOL). Dysphagia. 2013; 28(1): 11-23.
[38]  Carlsson S, Rydén A, Rudberg I, Bove M, Bergquist H, Finizia C. Validation of Swedish M. D. Anderson Dysphagia Inventory (MDADI) in patients with head and neck cancer and neurologic swallowing disturbances. Dysphagia. 2012; 27(3): 361-369.
[39]  Albini RMN, Soares VMN, Wolf AE, Gonçalves CGO. Knowledge of Nursing Professionals About the Care to Dysphagic Patients in Intensive Care Units. Rev CEFAC. 2013; 15(6): 1512-1524.